Fluconazole resistant oral candidiasis in HIV-infected patients.
OBJECTIVE
To evaluate the risk factors associated with the emergence of fluconazole resistant Candida spp. in HIV-infected patients with oral candidiasis.


METHODS
Candida spp. were isolated from oral swabs and tested in vitro for resistance to fluconazole. The factors potentially correlated with vazole-resistent Candida spp. infections were investigated.


RESULTS
Fifty-one out of 118 patients (43%) with oral candidiasis had fluconazole resistant Candida spp. The following factors were significantly associated with the development of fluconazole resistance: (1) more than five episodes of oral candidiasis in the previous year (P < 0.001); (2) fluconazole therapy in the previous 6 months (P < 0.001); (3) C3 category of HIV infection (P < 0.001); and (4) low number of TCD4+ cells (< 50 mm3, P = 0.002). According to multivariate analysis, previous therapy with fluconazole was the only risk factor that independently influenced the development of Candida spp. resistance (P = 0.003).


CONCLUSIONS
The prophylaxis and therapy of mild fungal infections in HIV-infected patients, which may lead to azole resistance, should be carefully considered.
Tumbarello
M
M
Department of Infectious Diseases, Catholic University, Rome, Italy.
Tacconelli
E
E
Caldarola
G
G
Morace
G
G
Cauda
R
R
Ortona
L
L
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002175:Candida / Q000187:drug effects; D002180:Candidiasis, Oral / Q000188:drug therapy* / Q000209:etiology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004352:Drug Resistance, Microbial; D015725:Fluconazole / Q000494:pharmacology* / Q000627:therapeutic use*; D015658:HIV Infections / Q000145:classification / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D010347:Patient Care Planning; D018579:Patient Selection; D012307:Risk Factors
D000935:Antifungal Agents; D015725:Fluconazole